Arterial Pathology Research Articles

Intramural coronary artery and myocardial pathology in captive tigers (Panthera tigris) and African lions (Panthera leo).

There is limited published data regarding cardiovascular disease in nondomestic felid populations. To address this knowledge gap, necropsy cases of tigers and lions with representative myocardial samples submitted to a diagnostic laboratory were histologically assessed with hematoxylin and eosin and Sirius red stains. A total of 32 submissions (15 tigers, 17 lions) were identified in a 4-year period. All tigers and lions had some degree of coronary artery lesions in the left ventricle and/or interventricular septum. Major findings included moderate to marked arteriosclerosis in 8 tigers (53%) and 4 lions (24%) and moderate to marked perivascular fibrosis in 10 tigers (67%) and 9 lions (53%). Moreover, 10 tigers (67%) and 8 lions (47%) had coronary artery lesions with variable degrees of perivascular cardiomyocyte degeneration and/or loss. To our knowledge, this is the first report describing coronary artery pathology in captive tigers and lions.

Sulodexide Inhibits Arterial Contraction via the Endothelium-Dependent Nitric Oxide Pathway.

Background/Objectives: Sulodexide (SDX) is a drug known for restoring the glycocalyx, thereby offering endothelial protection and regulating permeability. Additionally, it has antithrombotic and anti-inflammatory properties and has shown arterial vasodilatory effects. Endothelial cells play a crucial role in maintaining homeostasis, with their dysfunction being a key contributor to loss in vasodilatory response, especially in arterial pathologies. The aim of this study was to investigate the effects of SDX on stimulated vascular tonus in human arterial samples and to assess the function of the endothelial layer as a source of nitric oxide (NO). Methods: A total of 16 internal mammary artery remnants from coronary artery bypass graft surgeries were dissected into endothelium-intact and endothelium-denuded groups (n = 8 each). The arterial rings were equilibrated under tension, with their basal tonus recorded before and after phenylephrine stimulation. SDX's impact on arterial contraction was assessed through cumulative dose-response curves. NO synthase inhibitor (Nω-nitro-L-arginine methyl ester) was used to assess SDX's vasodilatory effect over the NO pathway. Results: SDX application resulted in concentration-dependent vasorelaxation in both endothelium-intact and endothelium-denuded groups at certain doses. However, the inhibitory effect of SDX was more pronounced in endothelium-intact rings at higher doses compared to endothelium-denuded rings (p < 0.05). Similar inhibition of contraction curves was achieved for both endothelium-intact and endothelium-denuded rings after L-NAME pre-incubation, suggesting a necessity for NO-related endothelial pathways. Conclusions: SDX exerts a concentration-dependent inhibition on arterial contraction, emphasizing the critical role of an intact endothelium and NO-mediated pathways in this process. This underscores SDX's potential in treating endothelial dysfunction-related pathologies.

Pathology of the Vertebral Arteries: Atherosclerosis, Pathological Deformity. Clinical Picture, Diagnosis and Treatment

Pathology of the vertebral arteries is the main cause of stroke in the vertebrobasilar basin. The article describes in detail the clinical picture, diagnosis of pathology of the vertebral artery — atherosclerosis and pathological deformity. Modern medical treatment and various types of reconstructive surgery are described. The authors presented all types of reconstructive operations on the vertebral artery described in modern literature.

Hospital Incidence and Treatment Outcomes of Patients with Aneurysms and Dissections of the Iliac Artery in Switzerland-A Secondary Analysis of Swiss DRG Statistics Data.

Background/Objectives: Aneurysms and dissections of the iliac artery (ADIAs) are significant vascular conditions often associated with aortic pathologies. Despite their importance, reports on isolated iliac artery pathologies are rare. This study aimed to investigate the epidemiology of ADIA in Switzerland including treatment incidence and hospital outcomes. Methods: A retrospective analysis of diagnosis-related group (DRG) statistics from 2011 to 2018 in Switzerland was conducted, identifying all cases of ADIA while excluding those with concomitant treatment of aortic pathologies. Age-standardized incidence rates and treatment outcomes were assessed, with multivariable logistic regression performed to identify factors associated with hospital mortality. Results: From 2011 to 2018, 1037 ADIA cases were hospitalized in Switzerland. Incidence rates for elective treatment were significantly higher in men than women, increasing in men from 1.5 to 2.4 cases per 100,000 men (p = 0.007), while remaining stable in women at around 0.2 cases per 100,000 women. Acute treatment incidence rates were lower but still higher in men, at 0.9 cases per 100,000 men and 0.2 cases per 100,000 women. Crude hospital mortality rates were lower for endovascular repair than open surgical repair in both elective (0.8% vs. 3.1%, p = 0.023) and emergency treatment (6.7% vs. 18.4%, p = 0.045). Multivariable analysis showed that endovascular repair was associated with significantly reduced hospital mortality compared to open repair (OR 0.27, 95%-CI: 0.10 to 0.66, p = 0.006). Conclusions: This nationwide study of iliac artery pathologies shows that the treatment incidence was about 10 times higher in men than in women for elective procedures, but only about five times higher for emergency treatment. Endovascular procedures were associated with significantly lower hospital mortality than open procedures, while hospital mortality rates were comparable for men and women.

Echographic pattern features of dissections of the extracranial parts of the brachiocephalic arteries

Purpose: to determine the frequency of various ultrasound signs of dissections of the extracranial parts of the brachiocephalic arteries, as well as to compare the results of ultrasound and neuroimaging methods in the diagnostics of dissections.Materials and methods. The study included data on 108 patients, among them 44 (40.7%) women, 64 (59.3%) men, mean age was 56 ± 14 years. All patients underwent duplex scanning of the brachiocephalic arteries, 53 patients underwent CT-angiography, and 99 patients underwent MRI.Results. The sensitivity of duplex scanning in the primary diagnosis of dissections in our study was 97.2%. In 40 patients (37%) with dissections according to duplex scanning the presence of dissection was also confirmed on CT-angiography or MRI. Expansion of the vessel diameter and the presence of intramural hematoma (IMH), as well as their combination, were the most common ultrasound signs of dissections in our study. In cases where dissection was not confirmed by CT-angiography or MRI data moderate echogenicity of IMH was noted significantly more often (p = 0.018). Of all the ultrasound signs of dissections, the highest share of coincidence with the signs obtained with neuroimaging diagnostic methods occurred with IMG.Conclusion. The most frequently recorded ultrasound signs of dissections were the expansion of the vessel diameter and the presence of IMG, as well as their combination. The results of the study showed a high sensitivity of the ultrasound method in detecting dissections, especially in the subacute and chronic stages, as well as to determine the causes of ischemic stroke in the differential diagnosis of brachiocephalic artery pathologies.

Dissection of the Celiac Trunk Is a Mild Disease

ObjectiveThe purpose of this study was to assess whether the presence of an aneurysmal or dissecting arterial disease was a risk factor of poor prognosis in patients presenting a dissection of the celiac trunk (CT). MethodsAll patients presenting a CT dissection between January 1, 2014 and June 30, 2022 were included. Patients with a CT dissection due to the extension of an aortic dissection were excluded. Les antécédents familiaux de dissection, de maladie anévrysmale, de maladie athéromateuse ou du tissu conjonctif, la pratique d’une activité physique ou sportive, un effort inhabituel les jours précédant la dissection ainsi qu’un traumatisme étaient recherchés. Family history of dissection, aneurysmal disease, atheromatous or connective tissue disease, physical activity or sport, an unusual effort in the days prior to the dissection and trauma were sought after. Ischemic or aneurysmal complications in the acute phase and the evolution of the dissection were evaluated and compared between patients with an isolated dissection and those presenting an aneurysmal or dissecting arterial disease. Results45 patients were included in the study. Twenty-three (51.1%) patients presented with symptomatic CT dissection, and 22 (48.9%) with asymptomatic CT dissection. All the patients initially had medical management alone. The mean follow-up was 32 ± 25 months and all patients were asymptomatic at the time last news. 24 (53.3%) presented an isolated CT dissection, and 21 (46.7%) a CT dissection associated with aneurysmal or dissecting arterial disease. There was no significant difference between patients with an isolated CT dissection and those with an associated dissecting or aneurysmal pathology. ConclusionCT dissection is a stable disease in the midterm, which makes it a mild arterial pathology, with or without aneurysmal or dissecting anomalies in another territory. The mechanical stress exerted on the CT by the arcuate ligament could be responsible for parietal trauma and favor the occurrence of a TC dissection.

A review of histopathologic and radiologic features of non-atherosclerotic pathologies of the extracranial carotid arteries.

Diseases of the carotid arteries can be classified into different categories based on their origin. Atherosclerotic carotid disease remains the most encountered arterial wall pathology. However, other less-common non-atherosclerotic diseases can have detrimental clinical consequences if not appropriately recognized. The underlying histological features of each disease process may result in imaging findings that possess features that are obvious of the disease. However, some carotid disease processes may have histological characteristics that manifest as non-specific radiologic findings. The purpose of this manuscript is to review various non-atherosclerotic causes of carotid artery disease as well as their histologic-radiologic characteristics to aid in the appropriate recognition of these less-commonly encountered pathologies.

Co-prevalence of arterial aneurysm location - a correlation analysis based on a retrospective cross-sectional observational study.

Background: The aim of this retrospective single-centre cross-sectional observational study was to investigate co-prevalence of arterial aneurysm location systematically. Patients and methods: Patients with the diagnosis of any arterial aneurysm from January 2006 to January 2016 were investigated in a single centre. Patients with hereditary disorders of connective tissue, systemic inflammatory disease, or arterial pathologies other than true aneurysms were excluded. Aneurysm locations were assessed for every patient included. For patients with at least two co-existing aneurysms, co-prevalence of aneurysm location was investigated by calculating correlation coefficients and applying Fisher's exact test. This study report is prepared according to the STROBE statement. Results: Of 3107 identified patients with arterial aneurysms, 918 were excluded. Of the remaining 2189 patients, 951 patients with at least two aneurysms were included in the study. Bilateral aneurysm combinations of paired iliac, femoral and popliteal arteries showed the highest correlation (ϕ=0.35 to 0.67), followed by bilateral combinations of subclavian (ϕ=0.36) and internal carotid (ϕ=0.38) arteries. Abdominal aortic aneurysms in combination with visceral artery aneurysms (ϕ=-0.24 to -0.12), popliteal arteries (ϕ=-0.22) and the ascending aorta (ϕ=-0.19) showed the lowest correlation, followed by the descending aorta in combination with the common iliac arteries (ϕ=-0.12 to -0.13). Conclusions: In our study sample, aneurysm co-prevalence was highly non-random. This should be considered in the context of aneurysm screening programs.

Inferior Pancreaticoduodenal Artery Pseudoaneurysm Causing Biliary Obstruction: A Case Report.

Visceral arterial aneurysms and pseudoaneurysms are rare but dangerous pathologies, with reported incidence of 0.01-0.2% of the worldwide population, as found on autopsy. Pancreaticoduodenal artery pathology accounts for approximately 2% of all visceral aneurysms; it is commonly caused by chronic inflammatory processes, such as pancreatitis or adjacent pseudocysts. Morbidity and mortality commonly result from rupture of the aneurysm itself, leading to life-threatening hemorrhage into the peritoneum or gastrointestinal tract. Here we present the case of a 64-year-old male patient with previous history of alcohol use disorder leading to chronic pancreatitis and prior embolization of an inferior pancreaticoduodenal pseudoaneurysm, who presented to the emergency department (ED) with abdominal pain, nausea, and vomiting, and was found to have a large recurrent inferior pancreaticoduodenal pseudoaneurysm with associated obstructive cholangitis and pancreatitis via contrast-enhanced computed tomography (CT) of the abdomen and pelvis. The patient was managed emergently by interventional radiology angiography with embolic coiling and percutaneous biliary catheter placement, and he subsequently underwent biliary duct stenting with gastroenterology. The patient was successfully discharged after a brief hospitalization after resolution of his pancreatitis and associated hyperbilirubinemia. Pancreaticoduodenal artery aneurysms and pseudoaneurysms are rare and dangerous visceral pathologies. Patients can be diagnosed rapidly in the ED with CT imaging and need urgent endovascular management to prevent morbidity and mortality.

Protein aggregates containing wild-type and mutant NOTCH3 are major drivers of arterial pathology in CADASIL.

Loss of arterial smooth muscle cells (SMCs) and abnormal accumulation of the extracellular domain of the NOTCH3 receptor (Notch3ECD) are the 2 core features of CADASIL, a common cerebral small vessel disease caused by highly stereotyped dominant mutations in NOTCH3. Yet the relationship between NOTCH3 receptor activity, Notch3ECD accumulation, and arterial SMC loss has remained elusive, hampering the development of disease-modifying therapies. Using dedicated histopathological and multiscale imaging modalities, we could detect and quantify previously undetectable CADASIL-driven arterial SMC loss in the CNS of mice expressing the archetypal Arg169Cys mutation. We found that arterial pathology was more severe and Notch3ECD accumulation greater in transgenic mice overexpressing the mutation on a wild-type Notch3 background (TgNotch3R169C) than in knockin Notch3R170C/R170C mice expressing this mutation without a wild-type Notch3 copy. Notably, expression of Notch3-regulated genes was essentially unchanged in TgNotch3R169C arteries. We further showed that wild-type Notch3ECD coaggregated with mutant Notch3ECD and that elimination of 1 copy of wild-type Notch3 in TgNotch3R169C was sufficient to attenuate Notch3ECD accumulation and arterial pathology. These findings suggest that Notch3ECD accumulation, involving mutant and wild-type NOTCH3, is a major driver of arterial SMC loss in CADASIL, paving the way for NOTCH3-lowering therapeutic strategies.

Pathology-based brain arterial disease phenotypes and their radiographic correlates

IntroductionBrain arterial diseases, including atherosclerosis, vasculitis, and dissections, are major contributors to cerebrovascular morbidity and mortality worldwide. These diseases not only increase the risk of stroke but also play a significant role in neurodegeneration and dementia. Clear and unambiguous terminology and classification of brain arterial disease phenotypes is crucial for research and clinical practice. Material and methodsThis review aims to summarize and harmonize the terminology used for brain large and small arterial phenotypes based on pathology studies and relate them to imaging phenotypes used in medical research and clinical practice. Conclusions and resultsArteriosclerosis refers to hardening of the arteries but does not specify the underlying etiology. Specific terms such as atherosclerosis, calcification, or non-atherosclerotic fibroplasia are preferred. Atherosclerosis is defined pathologically by an atheroma. Other brain arterial pathologies occur and should be distinguished from atherosclerosis given therapeutic implications. On brain imaging, intracranial arterial luminal stenosis is usually attributed to atherosclerosis in the presence of atherosclerotic risk factors but advanced high-resolution arterial wall imaging has the potential to more accurately identify the underlying pathology. Regarding small vessel disease, arteriosclerosis is ambiguous and arteriolosclerosis is often used to denote the involvement of arterioles rather than arteries. Lipohyalinosis is sometimes used synonymously with arteriolosclerosis, but less accurately describes this common small vessel thickening which uncommonly shows lipid. Specific measures of small vessel wall thickness, the relationship to the lumen as well as changes in the layer composition might convey objective, measurable data regarding the status of brain small vessels.

Superficial Femoral Artery Atherosclerosis Masquerading as Sciatica: Diagnosis and Conservative Management – A Case Report

BACKGROUND: Often misdiagnosed as sciatica, vascular disorders such as peripheral arterial disease (PAD) can lead to a decreased quality of life. CASE PRESENTATION: The patient was a 44-year-old female referred to physical therapy with diagnosis of right-sided sciatica and L5-S1 degenerative disc disease, reporting right hip pain radiating into the thigh and foot, and worsening calf cramping. Based on inconsistent exam findings with lumbar spine imaging, patient comorbidities, and medication review, there was suspicion of PAD. The patient was referred to vascular surgery with recommendation of arterial ultrasound evaluation per American College of Radiology imaging guidelines. OUTCOME AND FOLLOW-UP: Arterial duplex revealed moderate arterial insufficiency with right distal superficial femoral artery occlusion. Patient underwent a 12-week supervised exercise program using the Gardner-Skinner Protocol for conservative management. DISCUSSION: Recognizing clinical presentation of arterial pathology, knowledge of imaging guidelines, and interdisciplinary care are essential for optimal management of PAD, particularly in cases with atypical risk factors. JOSPT Cases 2024;4(1):22-29. Epub 8 January 2024. doi:10.2519/josptcases.2024.12102

Abstract TP182: Vessel Wall MRI in Diagnosis and Prognosis of Intracranial Vasculopathy

Introduction: High resolution vessel wall MRI (VWMRI) has been increasingly used in stroke patients to evaluate the arterial pathologies and underlying cause of stroke. We aimed to explore VWMRI features of intracranial vasculopathies in ischemic stroke patients and assess their associations with stroke mechanism and with clinical outcome. Methods: Ischemic stroke or TIA patients with intracranial vasculopathy as the potential cause of stroke were included if they underwent VWMRI (3D T1-weighted, pre- &amp; post- contrast, resolution isotropic 0.625 mm). The VWMRI features including the number of arterial lesions with thickened wall, presence of T1 hyperintensity, degree of enhancement [absent (0), mild (1), significant (2 =similar to infundibulum)], pattern of enhancement [eccentric, concentric, and mixed (both)] were evaluated by board certified neuroradiologists. Primary outcome was defined as recurrent stroke or other cardiovascular events. The association between clinical characteristic VWMRI features &amp; clinical outcome were examined. Results: A total of 46 patients [29 (63%) males; mean age (SD) 55.7 (15) years] were included. Among 41 patients (89%) had at least one lesion with thickened wall, 21 patients (51.2%) had multiple lesions, 28 (68.3%) had T1 hyperintensity, 39 (95%) had contrast enhancement (eccentric n=24, concentric n=10, mixed n=5 ) and 27 (66%) had significant enhancement. Overall, VWMRI suggested a different pathological mechanism of stroke in 16 patients comparing with the original impression. Higher creatinine and lower HDL levels were significantly (p&lt;0.05) associated with presence of multiple vs single lesion on VWMRI. LDL was significantly (p=0.04) higher in those with eccentric vs concentric enhancement. The median follow-up was 28.4 (IQR 13- 47) months, and primary outcome occurred in 6 (13.3%) patients. VWMRI features were not associated with the primary outcome. Conclusions: Presence of some degree of enhancement is common (95%) in patients with ischemic stroke attributed to intracranial vasculopathies. The VWMRI features were not associated with the primary clinical outcome. VWMRI may help to clarify the etiology of the stroke mechanisms. These findings warrant further evaluation in larger studies.

Coronary artery lesions in Takayasu arteritis.

Takayasu arteritis (TAK) is a granulomatous inflammation of vessels of large diameter, mainly affecting the aorta and its proximal branches, which is more common in young women. The incidence of coronary artery disease in TAK is unknown and not sufficiently studied. A literature review was performed for the period 2003 to 2023 using a search of the PubMed and Scopus scientific databases. We used the following key words to search the academic journal databases: "Takayasu arteritis", "coronary angiography", "myocardial revascularization", "coronary artery disease", "angina pectoris", and "myocardial infarction". The analysis of studies showed that coronary artery lesions (CAL) in TAK are not uncommon, being identified particularly in children and young individuals. Pathology of the coronary arteries increases the morbidity and mortality of TAK patients. In TAK, the ostia and proximal segments of the coronary arteries are more frequently affected, presenting as stenosis or occlusion with the development of stable coronary artery disease, unstable coronary artery disease, acute myocardial infarction, and sudden death. The diagnosis of TAK and coronary artery pathology is often complicated due to nonspecific manifestations and frequently the absence of symptoms. The treatment of patients with TAK with CAL is challenging and requires both pharmacological therapy and interventional or surgical methods of myocardial revascularization. Takayasu arteritis is a more prevalent cause of CAL development, especially in young patients, than previously believed, and cardiovascular death due to CAL is not rare. Early diagnosis of TAK with CAL, particularly occlusion or hemodynamically significant stenosis, and the prompt initiation of appropriate treatment prevent dangerous complications, reduce mortality, and improve prognosis.

Successful repair of the anomalous left coronary artery from the right pulmonary artery associated with aortic coarctation in the newborn

Anomalous left coronary artery from the pulmonary artery is a rare congenital pathology of the coronary arteries, which is associated with 90 % mortality during the first year of life, therefore it requires a detailed diagnosis and surgical intervention from the first days of the patient's life. The presence of additional congenital anomalies is a factor increasing the risk of surgery. We present a clinical case and successful hybrid approach for correction of anomalous course of the left coronary artery from the right pulmonary artery in combination with coarctation of the aorta in the newborn.

Mitochondrial Melatonin: Beneficial Effects in Protecting against Heart Failure.

Cardiovascular disease is the cause of physical infirmity and thousands of deaths annually. Typically, during heart failure, cardiomyocyte mitochondria falter in terms of energy production and metabolic processing. Additionally, inflammation and the accumulation of non-contractile fibrous tissue contribute to cardiac malfunction. Melatonin, an endogenously produced molecule, experimentally reduces the initiation and progression of atherosclerotic lesions, which are often the basis of coronary artery disease. The current review critically analyzes published data related to the experimental use of melatonin to forestall coronary artery pathologies. Collectively, these studies document melatonin's anti-atherosclerotic actions in reducing LDL oxidation and triglyceride levels, lowering endothelial malfunction, limiting adhesion molecule formation, preventing macrophage polarization to the M1 pro-inflammatory phenotype, changing cellular metabolism, scavenging destructive reactive oxygen species, preventing the proliferation and invasion of arterial smooth muscle cells into the lesioned area, restricting the ingrowth of blood vessels from the vasa vasorum, and solidifying the plaque cap to reduce the chance of its rupture. Diabetic hyperglycemia, which aggravates atherosclerotic plaque formation, is also inhibited by melatonin supplementation in experimental animals. The potential value of non-toxic melatonin as a possible inhibitor of cardiac pathology in humans should be seriously considered by performing clinical trials using this multifunctional molecule.

Prevalence of Peripheral Arterial Disease in a Primary Health Care Area Cerro Municipality

Summary: Cardiovascular diseases are the most important cause of death in subjects over 50 years of age in developed countries. Arterial pathology as a whole, whether presented as coronary, cerebrovascular, or peripheral arterial disease, is an important cause of chronic disease, functional limitation and decreased quality of life and is associated with greater general and specific morbidity. Objectives: Estimate the prevalence of peripheral arterial disease in its initial stages and the associated classic risk factors in a population from the primary health care area of the Cerro Municipality. Material and Methods: Population-based, prospective, longitudinal and cross-sectional, the study population included all subjects over 55 years of age, belonging to the Cerro Polyclinic who attended Angiology and Vascular Surgery consultation, in the period from 2012 to 2013. Of the 962 subjects treated, 707 were over 55 years old and of these, 94 met the inclusion criteria for the study. All of them knew the epidemiological purpose of the study and gave their consent. Results: 94 patients over 55 years of age participated in the study, with a prevalence at the time of inclusion of 13% diagnosed with PAD in its initial Fontaine stages. Conclusions: The prevalence of PAD, in its initial stages, was 13%, with 73.4% being asymptomatic and 27.6% symptomatic, the main risk factor being smoking with 57.5%, followed by Hypercholesterolemia and arterial hypertension, the association was confirmed with its location in other vascular beds, 14.9% in patients who had previously presented coronary events, 8.5% cerebrovascular events.

Intravascular ultrasound use in peripheral arterial and deep venous interventions: Multidisciplinary expert opinion from SCAI/AVF/AVLS/SIR/SVM/SVS

Percutaneous revascularization is the primary strategy for treating lower extremity venous and arterial disease. Angiography is limited by its ability to accurately size vessels, precisely determine the degree of stenosis and length of lesions, characterize lesion morphology, or correctly diagnose postintervention complications. These limitations are overcome with use of intravascular ultrasound (IVUS). IVUS has demonstrated the ability to improve outcomes following percutaneous coronary intervention, and there is increasing evidence to support its benefits in the setting of peripheral vascular intervention. At this stage in its evolution, there remains a need to standardize the use and approach to peripheral vascular IVUS imaging. This manuscript represents considerations and consensus perspectives that emerged from a roundtable discussion including 15 physicians with expertise in interventional cardiology, interventional radiology, and vascular surgery, representing 6 cardiovascular specialty societies, held on February 3, 2023. The roundtable’s aims were to assess the current state of lower extremity revascularization, identify knowledge gaps and need for evidence, and determine how IVUS can improve care and outcomes for patients with peripheral arterial and deep venous pathology.

Cerebral artery and brain pathology correlates of antemortem cerebral artery 4D flow MRI

Cerebral artery and brain pathology correlates of antemortem cerebral artery 4D flow MRI

Efficacy of human experts and an automated segmentation algorithm in quantifying disease pathology in coronary computed tomography angiography: A head-to-head comparison with intravascular ultrasound imaging

BackgroundCoronary computed tomography angiography (CCTA) analysis is currently performed by experts and is a laborious process. Fully automated edge-detection methods have been developed to expedite CCTA segmentation however their use is limited as there are concerns about their accuracy. This study aims to compare the performance of an automated CCTA analysis software and the experts using near-infrared spectroscopy-intravascular ultrasound imaging (NIRS-IVUS) as a reference standard. MethodsFifty-one participants (150 vessels) with chronic coronary syndrome who underwent CCTA and 3-vessel NIRS-IVUS were included. CCTA analysis was performed by an expert and an automated edge detection method and their estimations were compared to NIRS-IVUS at a segment-, lesion-, and frame-level. ResultsSegment-level analysis demonstrated a similar performance of the two CCTA analyses (conventional and automatic) with large biases and limits of agreement compared to NIRS-IVUS estimations for the total atheroma (ICC: 0.55 vs 0.25, mean difference:192 (-102-487) vs 243 (-132-617) and percent atheroma volume (ICC: 0.30 vs 0.12, mean difference: 12.8 (−5.91-31.6) vs 20.0 (0.79–39.2). Lesion-level analysis showed that the experts were able to detect more accurately lesions than the automated method (68.2 ​% and 60.7 ​%) however both analyses had poor reliability in assessing the minimal lumen area (ICC 0.44 vs 0.36) and the maximum plaque burden (ICC 0.33 vs 0.33) when NIRS-IVUS was used as the reference standard. ConclusionsConventional and automated CCTA analyses had similar performance in assessing coronary artery pathology using NIRS-IVUS as a reference standard. Therefore, automated segmentation can be used to expedite CCTA analysis and enhance its applications in clinical practice.